Does the Affordable Care Act apply to Employee Assistance Programs?

Employee Assistance Programs (EAPs) that provide for medical care would be considered group health plan coverage subject to the market reform requirements, unless the EAP meets certain criteria for being excepted.

First, the EAP must not provide significant benefits in the nature of medical care. For example, an EAP would meet this requirement if it provides only limited, short-term outpatient counseling for substance use disorder services (without covering inpatient, residential, or intensive outpatient care) and without requiring prior authorization or review for medical necessity. However, an EAP that provides disease management services (such as laboratory testing and prescription drugs) could not be excepted.